In Need of Career Advice

[CookieRoo9413, ASN, RN]

Hi all, I am still a pretty new nurse. I graduated in August of 2022 and started out in home health as a visiting nurse. To be honest, I never really wanted to work in a hospital as the idea of unstable patients terrified me. I'm not an adrenaline junkie and do not feel that I would thrive in emergency situations on a daily basis. I liked the idea of caring for people in their homes, and I worked as a home health aide during nursing school and loved it. So I really thought this would be the perfect job for me - it was also part of a residency program through a reputable hospital system so I thought I would be getting the appropriate training and additional education. But it did not work out - I ended up hating it, realizing I was still not ready to be seeing patients solo, and there was no work/life balance as I was taking so much documentation home with me. 

So, I left home health and took a job working in urgent care, which has honestly been a good fit for me in a lot of ways. I am a second career nurse, and my first career was in office administration, so in a lot of ways, this job is a mix of office work and nursing. In home health, I picked up good skills in patient assessment and wound care, and now in urgent care, I've done medication administration (mainly IM injections and PO), IV starts/IV fluids (though we don't do this a lot so I can't say I'm great at it, but I can get the less challenging ones), EKGs, POC testing, assessing patients in emergency situations, phone triage, etc. But the doctors and PAs are the ones doing the actual assessments, and the MAs do most of the vital signs and rooming (though we do help with it). I had an MA who is about to start nursing school ask how I feel about not getting a lot of patient contact and how I am at the desk a lot, and she is not sure that she would want to work in urgent care as a nurse because she'll lose all that she is learning. (We handle a lot of phone calls, calling patients with lab/x-ray results, handling incoming calls for patients with issues, sending prescriptions over to pharmacies, etc, and we also scan physicals into charts and handle WC documentation). It just made me feel like an inferior nurse. Sometimes I feel like a fake nurse because our patients are typically pretty low acuity, although we do get patients that should have went to the ER (chest pain with cardiac history, respiratory distress, anaphylaxis, etc). And we did have a code in our center recently (my very first one ever, which was terrifying). My job is stressful because we work with people, but nursing wise, it is not too bad (aside from the code and other emergent situations that pop up here and there). And we see A LOT of people, well over 100 a day especially during cold and flu season, and it's honestly making me dislike people more. Urgent care feels a little bit like the retail of the healthcare world. The good part about it being a busy center is that I am usually working with another nurse for most of the day (though not always the whole day), so I often work with nurses who have extensive ER and critical care experience. But I also worry that one day our urgent care will get rid of all RNs like other urgent care centers have done recently. 

I was also working per diem in a medical daycare for kids with complex medical needs (mainly Gtubes, a couple of ostomies, and one kid had a trach, but I never got officially signed off on trachs to care for him). I ended up leaving because it was a far commute, and I had to regularly go on a bus into the city to pick up/drop off the kids and was in 2 vehicle accidents during the short time I was there (though no one was hurt). So, now I am going to work for Bayada accompanying a child with medical issues at a local school one day a week (in addition to my full time job in urgent care).

So, my question is do I need hospital experience to feel like a competent nurse? Or is it possible for me to continue to grow in the settings I've been working in? I keep going back and forth in my brain that I need to get out of urgent care, stop being such a coward, and work in a hospital (once I get at least a year and a half to 2 years in - I've only been there about 11 months now, and I feel like a job hopper already). But then other days, I tell myself that it is silly to leave a job I don't hate because I am so afraid I will be miserable in the hospital setting. And my long term goals do not include hospital work anyway. I am interested in clinic work - possibly dialysis or a fertility clinic, or maybe as a nurse care manager in primary care or some other specialty setting. I have also considered psych, but I keep going back and forth on this one as well. My other interest includes working as an RN case manager or clinical educator for private duty home health. I was thinking of working in a long term care facility for pediatrics (there is one near me that has a good reputation and pays well). Part of me would like to do full time private duty peds, but the benefits are terrible, and I think I would miss working with other people. I have contemplated school nursing too, but as the primary breadwinner, I am not sure I could make this work unless I did school nursing along with another nursing job. 

I guess I feel like I'm driving myself crazy because I am so unsure of what to do. There are so many options in nursing, which is great, but it also drives my indecisive mind crazy! While I like urgent care, I think I miss being able to get to know your patients like you do in home health. Plus my hours are all over the place (we don't do 3 twelve hour shifts, we may do one 12 hour shift, one 9 hour shift, one 8 hour shift, and one 6 hour shift, and then it could be completely different the following week, it's every other weekend with a mix of day/evening shifts). 

So, should I try to get some hospital experience (there is a hospital near me that has amazing benefits and does not require a BSN), or do you think my urgent care and private duty/home health experience will set me up well for my future career goals? 

Thank you for taking the time to read this and for any advice you may have to offer!

[Okami_CCRN, BSN, RN]

You do whatever your heart desires, if you are content with your urgent care job and have no desire to work in a hospital then don't work in a hospital. 

I have done ICU, cardiac cath lab, insurance case management, inpatient case management, bed management and nursing education. There's tons to do at your own pace, when you want to do it. People will talk and chime in unnecessarily, it is up to you how to interpret the talking. 

[Red Shirt 6, CNA]

You will train and retrain as your career progresses so you will gain the skills and experience you really need. 

Some employers are better with a set schedule but if you like where you are and can deal with the odd hours then I will suggest staying. 

[CookieRoo9413, ASN, RN]

Okami_CCRN said:

You do whatever your heart desires, if you are content with your urgent care job and have no desire to work in a hospital then don't work in a hospital. 

I have done ICU, cardiac cath lab, insurance case management, inpatient case management, bed management and nursing education. There's tons to do at your own pace, when you want to do it. People will talk and chime in unnecessarily, it is up to you how to interpret the talking. 

Thank you so much for your input! You are absolutely right. My husband always says I worry too much about what other people think, and I just need to do what will work for me. I have decided to stay put where I am for now in urgent care (just got my annual review and will be getting the max 4% raise, yay!). I am also thinking of eventually picking up a more complicated case in private duty (trach/vent with an extended orientation), but I plan to get comfortable with my rather simple gtube case first. That way I will continue to learn more but at my own pace. 🙂

Thanks again for your response. Sorry for my delayed reply!

[CookieRoo9413, ASN, RN]

Red Shirt 6 said:

You will train and retrain as your career progresses so you will gain the skills and experience you really need. 

Some employers are better with a set schedule but if you like where you are and can deal with the odd hours then I will suggest staying. 

Thank you for your input! This is so true. It all depends on where you work what skills you will actually need and use. 

My hours are a bit wonky, and I do wish they weren't all over the place so much. But they have been flexible with me regarding my other job and when I need to take my daughter to Girl Scouts so I can't complain too much. 🙂

Thanks again for your response, and I apologize for my delayed reply!